After a long wait, the Government published its Build Back Better plan for health and social care in September last year and followed that up in December with its adult social care reform white paper. Between these two publications, it has set out extensive proposals covering how adult social care is paid for and funded, as well as wider system reforms aimed at delivering more personal care, building stronger links between social care and housing, and developing new models of care.
The social care reforms set out in the Build Back Better plan include a cap on maximum care costs that people are required to pay themselves, changes to the financial means test thresholds to make them more generous and the creation of a fair rate of care in respect of the fees councils pay providers. These changes, and others set out in the white paper, are to be funded through the 1.25% increase to National Insurance, which creates the new Health and Social Care Levy.
While there is much to support in the various proposals, we are concerned that funding raised through the levy is likely to be insufficient to cover the costs of the reforms and does nothing to address either immediate pressures in the here and now or other key issues that need tackling, such as unmet need and care worker pay to address recruitment and retention difficulties.
Placing under-funded reforms on top of a system that itself is already under funded and unsustainable presents a serious risk to the quality and availability of care and support and the ability of people who draw on it to live the life they want to lead.
That is why we are calling on the Government to allocate a greater share of the Levy to social care. It is a ready-made source of additional funding that could be directed towards front-line social care, to help ease pressures and provide a degree of stability in the immediate and near future. Failure to adequately fund social care also runs the risk of minimising councils’ ability to help mitigate demand pressures on the NHS. Care and support is essential in its own right but a sustainable NHS also depends on a sustainable social care system.
Of the estimated £36bn the health and social levy will raise over the three-year Spending Review period, only £5.4bn is ringfenced for social care in England. As councils plan how to pay for and provide services from April, it is becoming increasingly clear that many are concerned this allocated funding will fall short of covering the cost of the various care and support reforms. Alongside adequate funding to meet the ambitions in the reforms, councils also need clarity on the detail. The Local Government Association (LGA) is calling for Government to work closely with councils on detailed costings and to publish, at the earliest opportunity, its consultation on the associated guidance.
The Build Back Better plan and adult social care white paper offer a promising vision for the future of care and support. But without adequate funding for the reforms, the system itself, and the other big issues facing the sector that need addressing, that potential is highly unlikely to be realised.
Preventative measures within social care play a crucial role in councils’ wider efforts to improve the health of local populations, but we know from the Association of Directors of Adult Social Services (ADASS) budget survey that prevention spending is under pressure because of the scale of financial stresses on adult social care. On the one hand, there is clear recognition from directors that prevention spending is key to delivering savings and improving people’s health and independence. But on the other hand, spend in 2021/22 is only slightly higher than spend in 2017/18 and is lower in terms of spend on prevention as a percentage of the overall budget.
Ensuring people can stay independent in their own home for as long as possible, investing in new care workers and upskilling current staff, improving support to unpaid carers, and tackling unmet and under-met need would all have positive implications for people who have cause to draw on care and support. But this cannot and will not happen without adequate funding.
The rebuilding of adult social care and support so that it best enables people who draw on social care to live an equal life must be a legacy of the pandemic. In what the Government has put forward, there are strong foundations to build on. But without adequate support and financial provision those foundations will quickly erode, creating further pressure and uncertainty.